Psycho physiological disorder is also popularly known as psychosomatic disorder! It can be classified as follows:

The term psychosomatic was coined by Heinroth (1818). It was introduced with the study of the effect of emotion on the various body organs.

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However, the American Psychiatric Association prefers the term psycho physiological while referring to specific disorders and psychosomatics for the general approach to medicine in which physical, psychological and socio-cultural factors are considered. The term psycho physiologic itself emphasises the fact that we are talking about disorders caused and maintained mainly by psychological and emotional factors rather than by organised causes. In psycho physiologic dysfunction the psychological disorders or difficulties are expressed through some physiological pathology.

Experiments by Cannon and Bard in the early part of the 20th century on the effect of emotion on bodily changes stimulated large number of researches which brought about radical change in the discipline of psycho physiologic medicine.

Freud (1949) also believed that the pent up psychic energy does find its expression in physiological dysfunction. According to Alexander (1950) each type of psychosomatic disorder may be connected with specific types of stress. He viewed for instance, Peptic ulcer associated with the frustration of love need and the need for protection.

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Frustration of these needs he explained caused anger and anxiety which stimulated secretion of acids in the stomach. This leads to peptic ulcers. In Russia, based on pavlovian principles, studies on psychosomatic disorder were conducted. These studies were more objective and had an experimental basis.

To put it differently, in psychosomatic disorder, psychological life of an individual frequently influences his physical health. In fact the symptoms, the course and even the outcome of the physical disorders involve the interaction of physiological, psychological and social factors. They are always accompanied by emotional reactions which bring about pathological changes. There are plenty of evidences to show that in different physiological diseases psychological factors play a major role.

In the psycho physiological disorder there is a genuine physical disease which brings in physical dysfunction. Psychological and physiological factors are so related that which one is more urgent, is difficult to say. For example, in anxiety, the psychological and physiological factors are embedded in such a way that it is difficult to segregate their influence.

DSM 11 defines the psycho physiologic disorder as “characterized by physical symptoms that are caused by emotional factors and involve a single organ system usually under autonomic nervous system innervation.” (American Psychiatric Association, 1968).

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According to DSM IIIR the diagnostic criteria for psychosomatic disorder is psychologically meaningful environmental stimuli that are significantly and temporarily related to the initiation of a physical disorder. As an example, this may be a demonstrable organic pathology like rhematoid arthritis or a known physiological process like migraine headache.

1. Psychologically meaningful environmental stimuli are temporarily related to the initiation or exacerbation of a specific physical condition or disorder.

2. The physical condition involves either demonstrable organic pathology such as rheumatoid arthritis or a known physiological process like migraine headache.

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Although very few psychosomatic disordered persons take admission in hospitals, yet due to their life threatening consequences, these disorders require special attention. Psychologists have opined that if emotion or stress is the sole cause of psychosomatic disorder, then why different individuals choose different organ systems as sites for psychosomatic disorders instead of one particular organ? Three different guesses have been made by researchers as to why a particular psychosomatic disorder might be chosen.

Specific psychosomatic disorders occur in the organ system that is weakest this weakness may have a genetic or environmental cause. For example, if the weakest organ in a person is his digestive system and he experiences continued emotional stress; he may suffer from peptic ulcer.

The second explanation suggests that there are differences in inherited patterns of response to stress that may predispose people to develop specific system breakdowns. For example, people who have dependence — independence conflict may be more prone to develop ulcers. Similarly, some people respond to stress situation with high blood pressure, whereas others may respond to the breakdown of the respiratory system in the form of asthma.

According to the third explanation neither weak organ systems nor inherited response patterns, but specific types of personality patterns are principal cause for the development of psychosomatic disorders. In psycho physiological disorders, there are specific patterns of symptoms and the explanation and treatment for one type of psychosomatic disorder are usually not applicable to the other types.

The clinical picture of the psychosomatic disorders tends to be phasic i.e., there are periods of increase in the symptoms followed by a waning or disappearance of the symptoms. The sequence of their appearance or disappearance seems to be related to the amount of tension the individual is expressing. For example, an extremely busy business executive may find his ulcer being getting alright during a month’s vacation.

It is also interesting to note that there are marked differences between the sexes in the incidence of specific disorder. For instance, ulcers are much more common among men than in women. Similarly, rheumatoid arthritis is much more common among women than in men. From this classification it is clear that psycho physiologic disorders include a wide range of dysfunctions in which stresses and strains of life play a casual role.

Classification of psycho physiological disorders

In the APA classification 10 types of psycho physiological disorders are listed by taking symptoms into account.

10. Psycho physiologic disorders of other types — disturbances in the nervous system in which emotional factors play a crucial role — multiple sclerosis.

From this classification it is understood that a wide range of dysfunctions are included under psycho physiologic disorders in which stresses and strains of life play a casual role.

Presently, we will discuss some of the most common psycho physiologic dysfunctions.

Rheumatoid arthritis:

In this disease there is chronic muscular pain because of inflammatory disease of the joints. Allergic immunological and psychological factors and psychological stress predisposes patients to rheumatoid arthritis.

Low back pain:

Although low back pain may arise due to a raptured inter vertebral disc or a fracture of the back, congenital defects of the lower spine or a muscle strain may have a psychosomatic basis. Some reports show that 95 per cent of such cases are psychological in origin.

Cancer:

Though no clear cut evidence is available, large numbers of researchers have attempted to link personality traits with susceptibility to cancer and the increasing information’s on the immunological aspects of cancer hints at the possibility of psycho social influences like emotion, anxiety and depression etc. having something to do with the susceptibility to cancer cannot be ruled out.

Cardiovascular disorders:

The cardiovascular disorders are the outcome of emotional stress. They include diseases of the heart and blood vessels. Coronary heart disease and essential hypertension or high blood pressures are the two most important and frequently occurred heart diseases which lead to loss of life and several psychological dysfunctions. Besides, tachycardia or rapid heartbeat and anginal syndrome or pain in the region of heart are also major cardiovascular disorders having psychosomatic basis.

Coronary heart disease:

Coronary heart disease (CHD) ranks first as a cause of death. It may account for as many as 50 per cent of the deaths in the United States. There was a popular impression that only old people die of heart disease. But current evidences show that it is responsible for 1 out of 4 deaths of people between the ages of 35 and 64.

Kisker (1972) reports that one death in 4 among physicians in the U.S.A. between the ages of 45-65 years is due to this dysfunction. Evidences also indicate that more men suffer from heart disease than women. When a clot of blood forms within the coronary arteries, the muscles of the heart do not get proper blood supply and hence damage to the tissues is caused.

Clotting of blood (thrombosis) takes place more rapidly under stress situation and there is a positive relationship between clotting of blood and emotional stress. Emotional cause thus is said to be major cause of coronary heart disease. It is also reported that worry, anxiety, irritation and excitement tend to increase heart palpitation. This resists the flow of blood and increases clotting of blood thus causing obstruction to heart arteries and this can lead to death.

Macht (1972) conducted an investigation on blood bank donors to study the effect of emotion on blood coagulation time. Results indicated that the blood coagulation time was more for the calon group and less for the apprehensive, frightened and nervous group.

Research data also supports the fact that there is a significant interaction of psychological factors in producing CHD. Also in the studies of autopsies performed in Korea of injured U.S. soldiers of average age of 22, evidence of coronary disease was found in 77.3 per cent of the autopsied hearts. It might be presumed that the stresses of war caused such a high percentage of coronary disease.

Certain personality characteristics also seem to be related to CHD. Friedman and Rosenman (1959) concluded that there was a major behaviour pauern which they called ‘Type A personality’ associated with CHD. They seemed to live continuously under pressure without any leisure or relaxation. They had to work most of the time under stress and worry.

Essential hypertension:

Hypertension or high blood pressure is a very common disease of today. It is estimated to be found in about 50 per cent of the people over 40-45 years. In U.S.A. over 23 million persons suffer from chronically high blood pressure or hypertension.

Studies show that the occurrence of hypertension is twice as high among blacks as among whites. Hypertension is the most important cause of strokes and cardiovascular disease which ultimately leads to death. Heart is said to be most sensitive to emotional stress. During stress period the vessels of the visceral organ are tightened and greater amount of blood rushes to the muscles of the limbs and trunks. By restricting the tiny vessels to visceral organs; the heart is pressed to work harder. When the heart beats faster, the blood pressure rises.

If the emotional strain is chronic, the blood pressure remains high constantly leading to strokes and other cardiovascular diseases. It is also related to kidney failure. When the kidneys are deprived of blood, a substance called rennin is released from the kidney which raises the blood pressure. Before the rise of the blood pressure no warning signal is experienced. In some cases, tiredness, headache or dizziness is experienced. But usually there is no warning.

Though high blood pressure may be due to other organic factors also, Wolff (1953) and other investigators have shown that chronic and continuous hypertension may be aroused by severe emotional stress. Studies indicate that high blood pressure is more frequently found in urban areas, in areas undergoing rapid cultural change or socioeconomic mobility.

The psychoanalytic explanation of hypertension is that as opposed to neurotic people, the hypertensive people are unable to make people use of defenses and they have very few effective outlets of aggressive impulses. These aggressions are expressed through symptoms.

Headaches:

Headaches are neither destructive nor they kill persons. But they are very frequent and painful to the victim and headache is a very common attack, a psycho physiological experience. Coleman (1981) holds that 9 out of 10 seem to be related to emotional tension. Among the migraines and tension headaches, the migraine is very painful and disabling.

Migraine:

It is also called a vascular headache which recurs periodically. Its incidence is higher among women. A typical migraine headache involves only one side of the head. Nausea, vomiting and irritability commonly occur in severe attacks.

Temporary visual disorders proceed the headache. Also dizziness, sweating and other vasomotor disorders are experienced. Pain subsides when ergotamine is administered early in the attack. The duration of attack varies from person to person, but usually its duration is two to eight hours.

Causes:

Substantial evidences have been obtained in support of psychological factors in the causation of migraine headaches. As reported by Duke and Nowicki, (1979) “Kolb (1963) and Selinsky, (1939) described a typical migraine headache victim as a tense, inflexible personality maintaining a store of bottled up resentments that can neither be expressed nor resolved.” The patients also reported that they were in an emotionally stressful situation and felt tremendous amount of rage.

Henryk-Gutt and Rees (1973) in support of the above view found that migraine sufferers experienced more symptoms of emotional distress than controls though they did not differ in the real life stresses. Duke and Nowicki (1979) concludes in this connection “Although there is little argument with the conclusion that psychological stresses may be a significant precipitant of migraine attacks, migraine subjects appear to be predisposed by constitutional and not environmental factors to experience a greater reaction to the same quantity of stress than those who don’t have migraine headache.”

Tension headaches:

The majority of the simple headaches are known as tension headaches which include stress as well as vascular changes. Due to emotional stress muscles surrounding the skull contract, these contractions ultimately lead to simple tension headache.

Treatment:

The treatments of migraine headache can be both, physiological and psychological. Among the effective physiological treatments, tranquilizers, antidepressants drugs, histamine desensitization, surgery and special diets are noteworthy.

However, administration of ergotamine tartrate has been found to be the most effective psycho physiological treatment. In certain cases, attempts have been made to administer certain drugs to prevent headaches. But the dangerous side effects of migraine drugs and the risk of addiction have largely prevented its application.

It is simple and easy to treat tension headache in comparison to migraine headaches. Behaviour modification technique has been a current favourite to cure migraine headaches supported by the study of Mitchell and Mitchell (1973). Biofeedback methods have also been used with some success in the treatment of migraine headaches.

Asthma:

Asthma is a quite common attack like Migraine headache. When airways become restricted, they create breathing difficulty and asthmatic attack occurs. A severe attack of asthma make the individual suffer a lot the patient fights for air and suffers from convulsive coughing.

Coleman (1981) reports that the actual incidence of asthma is not known. Among the different types of asthma, that which appears to be intrinsic is elevated by emotional stimuli. It occurs in infancy as well as in late life.

The case of a young married woman, reported by Knapp (1969) who suffered from- severe asthmatic attack indicated that it was not sensitive to particular allergens rather it seemed to be directly related to her difficulty in handling aggression and hostility aroused out of interpersonal relationships.

It thus suggests that certain types of asthma are related to emotional stress and hence called psycho physiologic disorder. For the treatment of asthma, psychotherapy may be used. But Kelley and Zeller (1969) view that psychotherapy is not a very effective method of treating asthma.

Phillip, Wilde and Day (1971) suggest that hypnotism and suggestion may be more effective for those asthmatic patients who had a psychological cause for their asthma attacks. Relaxation training also may be helpful (Kotses, Glaus, Crawford and Scherr (1976).

Peshkin hypothesised a defective parent child relationship as the cause of asthma and moved the children from their home and put into a carefully supervised Milieu therapy. He found that 99 per cent of the asthmatic children responded to it.

Eczema:

According to Coleman (1981) eczema is a superficial inflammation of the skin characterised by redness, itching, pimples and the formation of crusts. As the skin is sufficiently supplied with blood vessels, it is a highly sensitive indicator of emotional states.

When the individual becomes angry, afraid or frightened or happy it is reflected in the skin. It has been noticed that severe stress and emotional distress develop some sort of psychosomatic skin reaction such as a rash.

A study by Brown (1972) on the relationship between emotional stress and eczema, indicated that the eczema patients described themselves as suppressing their emotional problem such as “feeling frustrated and unable to do anything about it.” Brown also reported a great frequency of marital problems among the asthma patients such as separation and divorce experiences. There have also been reports which prove that eczema reactions related with emotional stress clear up when the stress situation is alleviated.

The significance of eczema as a psychosomatic disorder is understood when Shelley and Edson (1973) comment that eczema may not take a person’s life, but they could take the enjoyment out of it.

Peptic ulcers:

The gastro intestinal system is a common path through which human beings express their emotions. Peptic ulcer is a type of gastro intestinal disorder which was first observed in western culture during the first part of the 19th century. The incidence of ulcer is 2 or 3 times greater among men than women.

Estimates indicate that about 7 to 10 per cent of the adults would develop ulcer at sometime during their life span. Pain after taking food is experienced and this can be reduced by taking food only. Nausea and vomiting may accompany pain. In severe cases, there may be bleeding. It is viewed that the physical symptoms are a function of organic and emotional factors.

Though there are several organic causes of ulcer, chronic repressed hostility, worry and anxiety, constant resentment and anguish and other stressful states stimulate the flow of stomach’s acid, than what is needed for digestion. Thus, excessive flow of the acid containing digestive juices of the stomach known as gastric secretions destroys the lining of the stomach which is called duodenum and leaves a crater like wound. This is called the ulcer.

The classic study by Wolff and Wolff (1947) along with a number of further studies support the importance of repressed hostility and other stressful experiences in the causation of peptic ulcer. Sustained emotional tension and lack of expression of negative emotions further aggravate the secretion of digestive acids called pepsin which aggravates the destruction of stomach lining tissue.

Peptic ulcer has two types of explanations, physiological and psychological. According to Duke and Nowicki (1979) physiological theory argues the role of conflict and stress in the development of stomach lining irritations. The physiological theorists argue that there is a physiological state – in some people which predisposes them to develop ulcer under continuous stress and emotional tension.

Studies conducted on animals and human beings further reveal that certain specific types of emotions may be associated to ulcer production. The view that mainly anger produced over secretions of gastric acid supports the view of psychoanalytic theorists like Alexander (1952) about the cause of peptic ulcer.

In an experimental study by Brady and et al. (1958; 1970) on monkeys at the Walter Reed Army Institute of Research, U.S.A., the relationship of stress to the development of ulcer was demonstrated. The monkey under stress (learning to press a lever at least every 20 seeds to avoid electric shocks to himself and a control monkey) developed ulcer while the control monkey who had no responsibility of avoiding shock did not develop any ulcer.By learning to handle the stress more effectively, the psychological problem of peptic ulcer can be solved.

Colitis:

It is a very painful gastrointestinal disorder characterised by symptoms of inflammation of the colon, severe crams and diarrhoea along with constipation, pain in the lower abdomen and bleeding. There are two kinds of colitis, such as mucous colitis and ulcerative colitis.

In the former the mucous lining of the colon is dissolved and may be eliminated in the stools. Consequently, pain is experienced every time while eating or eliminating. In case of ulcerative colitis, in the mucous membrane of the colon, an ulcer develops which leads to bleeding. It is found in all ages and once appeared can become chronic.

Colitis is said to be psycho physiologic, as an intimate positive correlation between colitis and emotional stress has been found. It has further been noticed that when a person experiences certain emotional stresses such as death of a near ones, failure in examination or unemployment, the symptoms of ulcerative colitis aggravate.

Genitourinary disorders:

Disorders in the urinary function due to emotional conflicts come under this category. As observation, experience and studies show, many people complain of frequent urination, of other urinary troubles though there is no real organic pathology. Such cases may be referred to the function of worries, anxieties, and emotional stresses.

Retention of urine similarly in many cases is found to be related to the emotional condition of the person. It has been found that the bladder function of certain persons is inhibited under certain unusual conditions, bed wetting or enuresis, a common behaviour disorder in childhood is a very common urinary disorder. Chronic conflict within the child is said to be the cause of it. Similarly, during war years it has been noted that bed wetting is a very common problem among men in army recruiting centres.

Menstrual disorders:

A menstrual disorder is called psycho physiologic when it is related to emotional stress. The onset of menstruation is usually coloured with emotion. Before the onset of menstrual period the secretion from the endocrine glands bring about some physiological changes making menstruation painful.

However, the premenstrual tension brings worry, depression, anxiety and the person becomes moody and restless. He shows irritability and annoyance over small matters. It is reported by Shanmugam (1981) that some women are even found to commit crimes during menstrual period though this view does not seem to be based on empirical evidences. Stressful situations like emotional shock, divorce, sexual conflict, death of a near relative also sometimes decrease or completely stop menstruation which is known as amenorrhea.

Disorder in sexual function:

Excessive feeling of guilt, fear of disease, hostility towards the members of the opposite sex, hatred and the like may bring about a number of problems in sexual relation in marital life. Among them impotence in case of males, and frigidity in case of females are the two most often found psycho physiological disorders associated with psychological explanations.

In impotence, the male member is unable to perform the sexual act, nor he is able to get pleasure and satisfaction out of it. Frigidity in case of females also may lead to lack of sexual feeling and decreased desire for sex, behind which usually there may be no organic basis.